A review of general surgery resident experience in common bile duct exploration in the ERCP era

Warner, Rachel; Coleman, K. Conley; Musgrove, Kelsey A.; Bardes, James M.; Borgstrom, David C.; Grabo, Daniel

doi:10.1016/j.amjsurg.2020.02.032

Cited by 10 publications

(4 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In Thailand, the number of ERCP procedures has significantly increased following global trends. On the other hand, the number of residents’ experiences in OCBDE has declined significantly as same as the previous study in the United States [ 21 , 22 ]. A novel simulation including fresh cadavers should be considered to enhance the open surgery skill to alleviate the loss of low-volume, complex procedures.…”

Section: Discussionsupporting

confidence: 72%

Trend of minimally invasive and open surgery experience of general surgery residents: Accreditation Council for Graduate Medical Education general surgery case log in Thailand

Eurboonyanun,

Aphinives,

Wittayapairoch

et al. 2023

J Minim Invasive Surg

View full text Add to dashboard Cite

Purpose Minimally invasive surgery (MIS) offers patients several benefits, such as smaller incisions, and fast recovery times. General surgery residents should be trained in both open and MIS. We aimed to examine the trends of minimally invasive and open procedures performed by general surgery residents in Thailand. Methods A retrospective review of the Royal College of Surgeons of Thailand and Accreditation Council for Graduate Medical Education general surgery case logs from 2007 to 2018 was performed for common open and laparoscopic general surgery operations. The data were grouped by three time periods, which were 2007–2010, 2011–2014, and 2015–2018, and analyzed to explore changes in the operative trends. Results For Thai residents, the mean number of laparoscopic operations per person per year increased from 5.97 to 9.36 (56.78% increase) and open increased from 20.02 to 27.16 (35.67% increase). There was a significant increase in the average number of minimally invasive procedures performed among cholecystectomy (5.83, 6.57, 8.10; p < 0.001) and inguinal hernia repair (0.33, 0.35, 0.66; p < 0.001). Compared to general surgery residents in the United States, Thai residents had more experience with open appendectomy, but significantly less experience with all other operations/procedures. Conclusion The number of open and minimally invasive procedures performed or assisted by Thai general surgery residents has slowly increased, but generally lags behind residents in the United States. The Thai education program must be updated to improve residents’ technical skills in open and laparoscopic surgery to remain competitive with their global partners.

show abstract

Section: Discussionsupporting

confidence: 72%

Trend of minimally invasive and open surgery experience of general surgery residents: Accreditation Council for Graduate Medical Education general surgery case log in Thailand

Eurboonyanun,

Aphinives,

Wittayapairoch

et al. 2023

J Minim Invasive Surg

View full text Add to dashboard Cite

show abstract

“…L-CBDE has shown comparable efficacy and advantages compared to ERCP, such as decreased length of stay and only requiring a single-stage procedure [ 38 , 39 ]. Despite this, modern surgical training programs have seen a significant decline in exposure to CBDE in recent decades, and many surgeons may not be comfortable in performing this directly out of surgical training [ 40 ]. However, Campagna et al had recently demonstrated that experienced rural general surgeons could gain and maintain procedural confidence in L-CBDE after a dedicated short-term training course [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and outcomes of choledocholithiasis and cholangitis in the United States: trends and urban-rural variations

Guizzetti²,

et al. 2023

BMC Gastroenterol

View full text Add to dashboard Cite

Background Gallstone disease poses a significant health burden in the United States. Choledocholithiasis and cholangitis are common complications of gallstone disease for which data on current epidemiological trends are lacking. We aimed to evaluate temporal changes in hospitalization, management, and outcomes for patients with choledocholithiasis and cholangitis. Methods The National Inpatient Sample was used to identify discharges for choledocholithiasis and cholangitis between 2005 and 2014. Temporal trends were evaluated via annual percent changes (APCs). Joinpoint regression was used to assess inflection points. Multivariable regression models were used to evaluate associations of interest. Results From 189,362 unweighted discharges for choledocholithiasis and/or cholangitis, there was an increase in discharges for choledocholithiasis (APC 2.3%, 95% confidence intervals, CI, 1.9–2.7%) and cholangitis (APC 1.5%, 95% CI 0.7–2.2%). Procedural interventions were more likely at urban hospitals for choledocholithiasis (adjusted odds ratio, aOR, 2.94, 95% CI 2.72 to 3.17) and cholangitis (aOR 2.97, 95% CI 2.50 to 3.54). In-hospital mortality significantly decreased annually for choledocholithiasis (aOR 0.90, 95% CI 0.88 to 0.93) and cholangitis (aOR 0.93, 95% CI 0.89 to 0.97). In-hospital mortality between rural and urban centers was comparable for choledocholithiasis (aOR 1.16, 95% CI 0.89 to 1.52) and cholangitis (aOR 1.12, 95% CI 0.72 to 1.72). Conclusions Hospitalizations for choledocholithiasis and cholangitis have increased between 2005 and 2014, reflecting a growing burden of gallstone disease. Hospital mortality between urban and rural centers is similar, however urban centers have a higher rate of procedural interventions suggesting limitations to accessing procedural interventions at rural centers.

show abstract

“…The experience of general surgery residents on CBD exploration has decreased due to the application of ERCP-ES. This training deficiency should be managed effectively[ 68 ].…”

Section: Managementmentioning

confidence: 99%

Current management of concomitant cholelithiasis and common bile duct stones

Pavlidis¹,

Pavlidis²

2023

World J Gastrointest Surg

View full text Add to dashboard Cite

The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one- or two-stage procedure. It basically includes either laparoscopic cholecystectomy (LC) with laparoscopic common bile duct (CBD) exploration (LCBDE) in the same operation or LC with preoperative, postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy (ERCP-ES) for stone clearance. The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC, preferably on the next day. In cases where preoperative ERCP-ES is not feasible, the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated. The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES. However, there is no consensus on the superiority of laparoendoscopic rendezvous. This is equivalent to a traditional two-stage procedure. Endoscopic papillary large balloon dilation reduces recurrence. LCBDE and intraoperative ERCP have similar good outcomes. The risk of recurrence after ERCP-ES is greater than that after LCBDE. Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones. The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage, but the transcystic approach must be used where possible. LCBDE is a safe and effective choice when performed by an experienced surgeon. However, the requirement of specific equipment and advanced training are drawbacks. The percutaneous approach is an alternative when ERCP fails. Surgical or endoscopic reintervention for retained stones may be needed. For asymptomatic CBD stones, ERCP clearance is the first-choice method. Both one-stage and two-stage management are acceptable and can ensure improved quality of life.

show abstract

A review of general surgery resident experience in common bile duct exploration in the ERCP era

Cited by 10 publications

References 16 publications

Trend of minimally invasive and open surgery experience of general surgery residents: Accreditation Council for Graduate Medical Education general surgery case log in Thailand

Trend of minimally invasive and open surgery experience of general surgery residents: Accreditation Council for Graduate Medical Education general surgery case log in Thailand

Epidemiology and outcomes of choledocholithiasis and cholangitis in the United States: trends and urban-rural variations

Current management of concomitant cholelithiasis and common bile duct stones

Contact Info

Product

Resources

About